cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2019-5-128-137cardiovascular-2231Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMПрофилактика желудочно-кишечных кровотечений у пациентов, получающих пероральные антикоагулянты: фокус на ингибиторы протонной помпыPrevention of gastrointestinal bleeding in patients receiving oral anticoagulants: focus on proton pump inhibitorshttps://orcid.org/0000-0002-0795-8225ОстроумоваО. Д.OstroumovaO. D.

Остроумова Ольга Дмитриевна — доктор медицинских наук, профессор, заведующий лабораторией клинической фармакологии и фармакотерапии РНИМУ им. Н.И. Пирогова, профессор кафедры клинической фармакологии и пропедевтики внутренних болезней ПМГМУ И М. Сеченова

ostroumova.olga@mail.ruhttps://orcid.org/0000-0002-5896-9063ВолковаЕ. А.VolkovaE. A.

Волкова Елизавета Александровна — студентка 5 курса, лечебный факультет

eliz0110@mail.ruhttps://orcid.org/0000-0001-5801-3742КочетковА. И.KochetkovA. I.

Кочетков Алексей Иванович — кандидат медицинских наук, научный сотрудник лаборатории клинической фармакологии и фармакотерапии, ассистент кафедры болезней старения факультета дополнительного профессионального образования

Moscow

ak_info@list.ruhttps://orcid.org/0000-0001-7168-3636ПереверзевА. П.PereverzevA. P.

Переверзев Антон Павлович — кандидат медицинских наук, н.с. лаборатории клинической фармакологии и фармакотерапии

acchirurg@mail.ruhttps://orcid.org/0000-0002-4193-688XТкачёваО. Н.TkachevaO. N.

Ткачева Ольга Николаевна — доктор медицинских наук, профессор, директор, президент Российской ассоциации геронтологов и гериатров, главный внештатный специалист гериатр Минздрава России

tkacheva@rgnkc.ruФГБОУ ВО “РНИМУ им. Н. И. Пирогова” Минздрава России — ОСП “Российский геронтологический научноклинический центр; ФГАОУ ВО “Первый Московский государственный медицинский университет им. И. М. Сеченова” Минздрава России (Сеченовский Университет)Russian Clinical and Research Center of Gerontology; I.M. Sechenov First Moscow State Medical UniversityФГБОУ ВО Московский государственный медико-стоматологический университет им. А.И. ЕвдокимоваMoscow State University of Medicine and DentistryФГБОУ ВО “РНИМУ им. Н. И. Пирогова” Минздрава России — ОСП “Российский геронтологический научноклинический центрRussian Clinical and Research Center of Gerontology201930102019185128137Copyright © Остроумова О.Д., Волкова Е.А., Кочетков А.И., Переверзев А.П., Ткачёва О.Н., 20192019Остроумова О.Д., Волкова Е.А., Кочетков А.И., Переверзев А.П., Ткачёва О.Н.Ostroumova O.D., Volkova E.A., Kochetkov A.I., Pereverzev A.P., Tkacheva O.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2231

В обзоре рассматривается проблема развития желудочно-кишечных кровотечений (ЖКК) у пациентов, получающих пероральные антикоагулянты, и возможности ингибиторов протонной помпы (ИПП) в снижении частоты таких осложнений. Представлены эпидемиологические данные о распространенности ЖКК на фоне приема новых оральных антикоагулянтов (НОАК) и варфарина. Обсуждаются факторы, повышающие риск кровотечений, ассоциированных с применением антикоагулянтов, в т.ч. потенциально возможные межлекарственные взаимодействия и особенности рациона питания больных. Дано описание шкал, оценивающих вероятность развития кровотечений на фоне антикоагулянтной терапии. Во второй части обзора рассматриваются принципы профилактики и минимизации риска ЖКК при назначении НОАК. С точки зрения доказательной медицины подробно обсуждается роль ИПП в снижении риска ЖКК. Детально описаны результаты масштабных рандомизированных, клинических исследований и мета-анализов последних лет, свидетельствующие о способности ИПП благоприятно влиять на риск кровотечений из верхних отделов желудочно-кишечного тракта при приеме НОАК и варфа-рина, особенно при сопутствующей терапии ацетилсалициловой кислотой, благодаря чему ИПП могут рассматриваться в качестве одного из эффективных “инструментов” медикаментозной профилактики указанных осложнений.

The review addresses the issue of the gastrointestinal bleeding (GIB) development in patients receiving oral anticoagulants, and the proton pump inhibitors (PPIs) efficiency in reducing of such complications. Epidemiological data on the prevalence of GIB in the presence of nonwarfarin oral anticoagulants (NOACs) and warfarin intake are presented. The factors that increase the risk of bleeding associated with the use of anticoagulants are discussed, including the potential drug-drug interactions and patients’ dietary habits. A description of the scales that assess the bleeding risks during anticoagulant therapy is given. In the second part of the article the principles of prevention and minimization of the GIB risks in the presence of oral anticoagulants treatment are presented. In the context of evidence-based medicine, the PPIs’ role in reducing the risk of GIB is fully discussed. The results of recent large-scale randomized clinical trials and meta-analyses are described in detail, suggesting the benefits of PPIs in the decreasing the risk of the upper gastrointestinal tract bleeding when NOACs and warfarin are prescribed, especially with concomitant therapy with acetylsalicylic acid. So, PPIs can be considered as one of the effective drug prevention “tools” of these complications.

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The authors declare that there are no conflicts of interest present.